Quality doesn’t come from inspection, pressure, or choosing between speed and accuracy. It comes from well-designed systems, capable processes, and leaders who focus on learning instead of blame. This archive brings together blog posts, podcasts, and reflections on quality through a Lean and Deming lens—covering psychological safety, metrics, variation, leadership behavior, healthcare quality, and why sustainable improvement depends on fixing systems rather than managing people harder.
In recent years, there’s been a movement away from having first-year residents work such long grueling hours – 24 hour shifts or longer, multiple days in a row on call, etc. The idea was that fatigued residents were making poor…
I always get annoyed when people spread the false dichotomy of “Lean is about efficiency and Six Sigma is for quality.” Replace the word “efficiency” with “speed” or “flow” and it’s still wrong. Here is an example of this falsehood…
My guest for episode #168 is Carolyn McCulley, from CityGate Films, and she is a co-director and producer of the upcoming documentary called “Breaking the Wall of Silence,” which sheds light on patient safety challenges in healthcare — but more…
As a reminder, I am giving a free Gemba Academy webinar tomorrow (Tuesday 3/12) on “Stories about the Eight Types of Waste in Healthcare.” Click here to learn more and sign up. I’m going to tell some stories from my…
“A bad system, will defeat a good person, every time.” — W. Edwards Deming Would you polish drinking glasses at home with the furniture cleaner Lemon Pledge? Of course not – it’s got to be poisonous or at least harmful.…
Last year, the Institute of Medicine released its latest report titled, “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America.” The report endorsed Lean as one strategy for improving the problems in our health care…
Thanks to ASQ for posting an audio interview they did with me last month about my book (with Joe Swartz), Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements. Listen to the interview (MP3 file – 14 minutes) ASQ also…
Here is a commentary that was written by Gary S. Kaplan, MD, the CEO of Virginia Mason Medical Center: “The Lean Approach to Health Care: Safety, Quality, and Cost.” More than a decade ago, Kaplan and the team at VMMC…
Last week, while flying back from my trip to Japan, I watched a video that had been recommended to me a few times (including by my local San Antonio IHI Open School friends): “Escape Fire: The Fight to Rescue American…
TL;DR: An andon cord is not primarily a line-stopping device. At Toyota, it’s a signaling system that allows workers to call for help immediately. Most problems are resolved before production stops. Its deeper purpose is to protect quality and create…
In a car assembly plant, they do a pretty good job of ensuring that no assembly line worker has to do 70 seconds worth of work in a 60 second job cycle. It’s basic Industrial Engineering and, well, it’s relatively…
Yesterday’s PBS News Hour had a piece on the use of Lean and the Toyota Production System at Seattle’s Virginia Mason Medical Center:
